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RN-Utilization Review - Hanover Maryland
Company: Ascension Location: Hanover, Maryland
Posted On: 04/17/2024
We offer free parking to all associates!Seeking experienced Utilization Review nurse.Will consider training an RN with 3+ years of recent acute care experience.The UR RN reviews prospective, concurrent, and retrospective cases for medical necessity while using reimbursement policy criteria.Position requires a self-motivated individual, with critical thinking skills, decisive judgment, strong communication skills - verbal and written, and clinically strong knowledge base.Direct patient interaction required.On-site work Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community -*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics. Responsibilities Provide health care services regarding admission, case management, discharge planning and utilization review. - Review admission and service request within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
- Provide case management and/or consultation for complex cases.
- Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Assess and coordinate discharge planning needs with healthcare team members.
- May prepare statistical analysis and utilization review reports as necessary.
- Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Requirements Licensure / Certification / Registration: - Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.Education:
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